Over the past five years, I have learned a lot. However, at many times, learning about drugs is similar to taking a sip of water from a fire hose. You tend to get a lot more than you expect.
Along with random bits of drug information, there are also many valuable life lessons that I learned. Below are the five most important medical/drug concepts that can be used as metaphors for life.
I think these are relevant for all people, regardless if you have a medical background or not. Disclaimer: many of these may be influenced by my Oregonian bias, unconventional upbringing, and obsession with Elon Musk.
1. LIFESTYLE MANAGEMENT OF CHRONIC DISEASES
I find it incredible how much potential individuals possess in overcoming chronic illnesses. The American Heart Association states, ““Cardiovascular disease is the leading global cause of death, accounting for more than 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030.” Cardiovascular disease, along with diabetes, is one of the most prevalent, yet treatable illnesses in the United States.
Although I love my drugs, there is nothing more effective in treating these conditions than significant lifestyle changes. A balanced diet, regular exercise, and maintenance of a healthy weight can have a tremendous impact on the progression of chronic diseases. Some sources have even noted a reverse in the status of a disease based on diet and lifestyle changes alone.
Similarly, Chronic Obstructive Pulmonary Disease (COPD) and Alcoholic Liver Cirrhosis are two diseases in which, at many stages, the progression can almost be completely halted by abstinence of tobacco or alcohol.
Of course, this does not speak for all cases of disease, as studies show that there is definite genetic disposition in comorbidities. However, the power that weight loss, exercise, good sleep, and smoking cessation has over these conditions should not be undermined.
As a pharmacist, and with the knowledge of the power of medicine, I cannot understate the power of therapeutics in altering the nature of these diseases. However, if a person refuses to take an aspirin and statin once a day, then there is not much I can do to help them. Being proactive in health is key to longevity.
For me, this concept can be thought of as a metaphor for not being proactive in life. Many times I find myself going with the flow because I am either too busy or lazy to do anything about it. Carpe diem: seize the day without letting the day give you a seizure. This was, in fact, one of the most important things learned from pharmacy school.
Lesson: take hold of life by “grabbing the bull by the horns”. Otherwise you will be the bull, and no one wants to be a bull.
2. HERBAL SUPPLEMENTS ARE STILL RELEVANT
Okay, now this one about 90% of pharmacy students and the medical field would probably disagree with me on. Here is my logic: many problems and medical conditions are based on symptoms. This includes a range from pain conditions (back pain, joint pain, osteoarthritis) to depression. By saying this, I am in no way invalidating these conditions, as I believe they are very serious. However, if you think about it, there is no way of objectively measuring the status of the disease state through lab tests or vital signs. Therefore much of the treatment of these conditions is solely based around making the patient feel better. Furthermore, a patient’s belief that they will get better can be more beneficial than the medication they are taking (placebo effect).
The reason that modern medicine does not favor the use of herbals is often times because of the lack of clinical efficacy reported from a randomized controlled trial. However, I believe that if a patient reports feeling better from a symptomatic based condition by taking an herbal remedy, then I would completely recommend the product if there are no safety concerns or interactions with the rest of their medications. I do not think there is a reason to discount all herbal remedies from medicine, simply because they are herbals. After all, many modern medicines originally came from herbals (lovastatin – red yeast rice, digoxin – digitalis, aspirin – willow bark, morphine – opium poppy).
In the case of herbal supplements, healthcare practitioners need to question what they are taught. This is also true throughout life. In school, I was always the person to ask the question, “Why?”. While most people found it annoying and contrary to the well-tested study method of “memorize & dump,” I found that I gained a greater conceptual understanding by digging deeper into subject matter. Similarly, the smartest minds of our time have asked the question of why. Teslas and iPhones would not be in existence today, unless Elon Musk and Steve Jobs asked of mankind’s status quo, “Why?”, or maybe even more importantly, “Why not?”
Lesson: Question everything you are told–most people are completely wrong about most things. Or maybe they just have not found the better answer that is yet to come.
3. ALWAYS FINISH THE FULL COURSE OF ANTIBIOTICS
Antibiotics are not a cheese and cracker appetizer plate that when you feel satisfied, you toss the rest. Antibiotics are not a balloon that you play with for a while, but then let fly away when you are bored with it. Antibiotics are not a university that you go to for a few years, have fun, play some intramurals, then run out of money and drop out. Okay, hopefully no one is doing that last one, but am I getting the point across?
One major topic in the field of clinical pharmacy and medicine alike is the reality of antibiotic resistance. Each day, more and more bacteria become resistant to time tested antibiotics like amoxicillin and ciprofloxacin, along with many other types. That means each day, providers have less and less ways of treating bacterial infections in patients.
The reason it is important to finish the dose of antibiotics is to prevent future resistance. Each time you take antibiotics, there will be microbes that survive and become resistant. The body’s immune system generally takes care of them. However if someone does not take the full dose of antibiotics because they feel better after a day or two, they may leave too many resistant microbes for the immune system to handle. These microbes will then replicate and cause an antibiotic resistant infection. Then they pass it to their young child who sneezes on you continuously during the 12 hour plane ride back from China. Subsequently, we all die. Does that make sense?
As one of my dear friends just told me: consistency is key. Similarly to completing a full course of antibiotics, finish what has been started. I am quite fallible to this moral. There are many times when I would jump full-heartedly on a new idea I had, only to get bored of it and dump it a few days later. People have a tendency to find the newest and most exciting things, but even more people can appreciate when a project or mission is finished and well done.
Lesson: be consistent and complete in everything you do.
4. CERTAIN DRUGS WILL ALWAYS INTERACT
Drug interactions, although quite common, range from being insignificant to life threatening. Although there are a variety of reasons why these occur, common reasons include an over-capacity liver, kidney, or protein in the blood called albumin. This will cause drug levels in the body to either rise or lower, but will almost always lead to a problem. Examples of drugs with a million drug interactions are amiodarone, carbamazepine, ketoconazole, and warfarin. Many times the drug will be switched to one that interacts less, but sometimes it is unavoidable. Furthermore, the more drugs a patient is on, the more potential there is for interaction. The situation of a patient being on too many drugs that may be causing possible side effects or drug interactions is known as polypharmacy. A pharmacist’s goal is eliminate unnecessary medications and reduce side effects, much like cleaning out the closet.
I think in life there are always things that hold people back from pursuing their goals and dreams. In some instances, there is one simple distraction that gets in the way. Much like drugs that interact, sometimes there is a need to clean out the obstacles in life and replace them with things that are going to be more beneficial to success.
Lesson: live your life, ask Rihanna and T.I.
5. BRAND NAME PRODUCTS ARE NOT ALWAYS BETTER
I cannot count the numerous amounts of patients I have had, that after I spend 15 minutes showing them the EXACT same active ingredient of acetaminophen, still are convinced and consequently buy name brand Tylenol for double price.
Patients are often still deceived by brand versus generic. There is very little to no clinical difference between brand and generic drugs. The process of the FDA approving generic drugs is very intensive to ensure clinical efficacy. This principle was fostered by the “Drug Price Competition and Patent Term Restoration Act of 1984,” also called the Waxman-Hatch Act. Furthermore, pharmacists have a resource called the orange book which allows them to determine whether a certain generic will have bio-availability (amount of drug received by the body) as the alternative.
This might be a little bit of a stretch, but the metaphor I garner from this example is to not assess value solely by outside appearance; instead, to invoke a cliche, what really matters is what’s inside. In this age of social media, it is easy to falsely project oneself into something they are really not. True value comes from inner character.
Lesson: honestly, because why not, be yourself.
One concept that may sum up my PERSONAL experience is the current role of pharmacy in society. Many people, when I tell them I am going to be a pharmacist, tell me how bad the pharmaceutical companies are and how people are taking drugs to fix every problem in their life, even when they shouldn’t be on them. Well, maybe that is how pharmacy used to be. The lesson I learned is that your role is what you make it, regardless of your profession. For me as a pharmacist, I believe that my role is to be the drug expert. This means that every time a patient has a condition deemed serious enough to be taking medicine, I have an opportunity to speak to that person.
Healthcare is defined by the Merriam-Webster Dictionary as, “the maintaining and restoration of health by the treatment and prevention of disease” As a pharmacist, I am a healthcare provider. Although I have knowledge about medicine, my services are dictated by the need of the patient at hand. My role may be to advise against use of a medication if I believe it may be detrimental to the patient. Pro-pharmacy does not necessarily mean pro-pharma. The principle of beneficence requires me to do what is in the best interest of my patient.
I am hoping these lessons will serve me well on rotations this year.
Dane Michaelangelo Fickes
1. Heart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association. (2015). Circulation, 135(10). doi:10.1161/cir.0000000000000491
2. Center for Drug Evaluation and Research. Abbreviated New Drug Application (ANDA): Generics. Retrieved May 09, 2017, from https://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/AbbreviatedNewDrugApplicationANDAGenerics/